O'Halloran C, Walsh N, O'Grady M C, Barry L, Hooton C, Corcoran G D, Lucey B
a Department of Biological Sciences , Cork Institute of Technology , Bishopstown , Cork , Ireland.
b Department of Clinical Microbiology , Cork University Hospital , Wilton , Cork , Ireland.
Br J Biomed Sci. 2018 Jan;75(1):24-29. doi: 10.1080/09674845.2017.1392736. Epub 2017 Dec 6.
As many clinical laboratories convert between Stokes, Clinical and Laboratory Standards Institute (CLSI) and European Committee for Antimicrobial Susceptibility Testing (EUCAST) methods, the problem of comparing differently derived sets of antimicrobial susceptibility testing (AST) data with each other arises, owing to a scarcity of knowledge of inter-method comparability. The purpose of the current study was to determine the comparability of CLSI, EUCAST and Stokes AST methods for determining susceptibility of uropathogenic Escherichia coli to ampicillin, amoxicillin-clavulanate, trimethoprim, cephradine/cephalexin, ciprofloxacin and nitrofurantoin.
A total of 100 E. coli isolates were obtained from boric acid urine samples from patients attending GP surgeries. For EUCAST and CLSI, the Kirby-Bauer disc diffusion method was used and results interpreted using the respective breakpoint guidelines. For the Stokes method, direct susceptibility testing was performed on the urine samples.
The lowest levels of agreement were for amoxicillin-clavulanate (60%) and ciprofloxacin (89%) between the three AST methods, when using 2017 interpretive guidelines for CLSI and EUCAST. A comparison of EUCAST and CLSI without Stokes showed 82% agreement for amoxicillin-clavulanate and 94% agreement for ciprofloxacin. Discrepancies were compounded by varying breakpoint susceptibility guidelines issued during the period 2011-2017, and through the inclusion of a definition of intermediate susceptibility in some cases.
Our data indicate that the discrepancies generated through using different AST methods and different interpretive guidelines may result in confusion and inaccuracy when prescribing treatment for urinary tract infection.
由于许多临床实验室在斯托克斯（Stokes）方法、临床和实验室标准协会（CLSI）方法以及欧洲抗菌药物敏感性试验委员会（EUCAST）方法之间进行转换，由于缺乏方法间可比性的知识，出现了相互比较不同来源的抗菌药物敏感性试验（AST）数据集的问题。本研究的目的是确定CLSI、EUCAST和斯托克斯AST方法在测定尿路致病性大肠杆菌对氨苄西林、阿莫西林-克拉维酸、甲氧苄啶、头孢拉定/头孢氨苄、环丙沙星和呋喃妥因的敏感性方面的可比性。
从全科医生诊所患者的硼酸尿样本中获得了总共100株大肠杆菌分离株。对于EUCAST和CLSI，使用 Kirby-Bauer 纸片扩散法，并根据各自的折点指南解释结果。对于斯托克斯方法，对尿样进行直接药敏试验。
在使用CLSI和EUCAST的2017年解释性指南时，三种AST方法之间阿莫西林-克拉维酸（60%）和环丙沙星（89%）的一致性水平最低。EUCAST和CLSI之间（不包括斯托克斯方法）的比较显示，阿莫西林-克拉维酸的一致性为82%，环丙沙星的一致性为94%。2011年至2017年期间发布的不同折点敏感性指南以及在某些情况下纳入中介敏感性的定义加剧了差异。
我们的数据表明，在为尿路感染开处方时，使用不同的AST方法和不同的解释性指南所产生的差异可能会导致混淆和不准确。
